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The health-care killer, a documented category of serial killer, is a rare type of criminal, says a Western University criminology professor who studies murderers and their motives.

“They’re still not very well understood,” said Michael Arntfield, a former London police officer who wrote the bestseller Murder City, a study of a spate of serial murders in the London area over four decades.

Forty-one cases of health-care killers have been documented in the United States since 1970, he said, and none he knows of in Canada.

The American case of Donald Harvey, known as the Angel of Death, first sparked investigations into the prevalence of health-care homicides, Arntfield said.

Harvey murdered nearly 60 people while working as an orderly in various hospitals between 1970 and his arrest in 1987 usually by administering drugs.

The majority of 40 other known cases, Arntfield said, have occurred in hospitals and usually involved nurses using drugs often undetectable such as potassium chloride or certain respiratory drugs only available at hospitals.

Murders in seniors’ home are the most rare — only eight in the literature — and are usually committed by nurses aides. Often, Arntfield said, they are team killings involving two people. Most often they involve asphyxiation.

The cases largely go undetected. Often, in the death of an elderly person, an autopsy isn’t ordered, or, if they are, they don’t screen for the certain drugs used to cause the deaths, he said.

Those convicted are an even split between men and women, with a smattering more women convicted.

Arntfield said that initially they suffer from “Mother Teresa syndrome,” a variation of a narcissistic personality disorder “where these people have some delusions of being a hero or a saviour.

“(They) feel the need to intervene or intercede in someone’s suffering even if they’re making no complaints about it or even if they’re not necessarily palliative,” he said.

Often, the killing “may begin with someone who is terminal and they see themselves genuinely as ending their misery,” Arntfield said.

“Then what happens is they become less and less selective about who they kill.”

Arntfield said the killers look for those who have “do not resuscitate” orders or are unlikely to have an autopsy.

The initial compassion “becomes compulsive,” he said. Some convicted killers have told researchers “there is some thrill of being part of the emergency or the drama that they cause.

“It is . . . ultimately about the perception of power and playing God.”

The cases are difficult to investigate because there are no living witnesses, or, in the case of seniors’ homes, they are often people who suffer from Alzheimer’s and dementia.

“They’re very shrewd in terms of who they select, when they do it,” Arntfield said. “There’s significant pre-meditation that goes into it and tremendous planning and organization.”

Her case began its slow trek through the courts with her first court appearance in Woodstock while the rest of the region comes to terms with the deaths of eight seniors living in long-term care homes — seven in Woodstock and one in London. None of the charges have yet been proven in court.